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      Differences in Rehabilitation Needs after Stroke: A Similarity Analysis on the ICF Core Set for Stroke

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          Abstract

          Background: Successful rehabilitation is associated with physical, psychological, environmental, social, and personal factors based on the International Classification of Functioning, Disability and Health (ICF) framework. The influence of age has been suggested as crucial personal factors that may affect rehabilitation needs in post-stroke survivors. The aim of this study was to investigate the qualifiers of the ICF core set for stroke to detect differences in rehabilitation needs and goals between older (O, >65 years old) and younger (Y, ≤65 years old,) post-stroke individuals. Materials and methods: In this observational study, the comprehensive core set for stroke was filled during the rehabilitation period. Patient information was obtained using disability scales and translated into certain ICF categories using linking rules. Frequency, similarity, and linear regression analyses were performed for ICF qualifier profiles among Y and O patients. Results: Forty-eight ICF variables were significantly different between Y ( n = 35, 46.17 ± 11.27 years old) and O ( n = 35, 76.43 ± 6.77 years old) patients. Frequency analysis showed that activity of daily living and basic needs were more prevalent in O patients, whereas regaining of social role and social life were more prevalent in Y patients. The average Jaccard Index result (similarity analysis) was more homogeneous in O than in Y patients. Conclusions: ICF qualifiers are useful to design patient-centered care. Y patients have more heterogeneous needs and require more personalized program than O patients.

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          Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study).

          The incidence of stroke is predicted to rise because of the rapidly ageing population. However, over the past two decades, findings of randomised trials have identified several interventions that are effective in prevention of stroke. Reliable data on time-trends in stroke incidence, major risk factors, and use of preventive treatments in an ageing population are required to ascertain whether implementation of preventive strategies can offset the predicted rise in stroke incidence. We aimed to obtain these data. We ascertained changes in incidence of transient ischaemic attack and stroke, risk factors, and premorbid use of preventive treatments from 1981-84 (Oxford Community Stroke Project; OCSP) to 2002-04 (Oxford Vascular Study; OXVASC). Of 476 patients with transient ischaemic attacks or strokes in OXVASC, 262 strokes and 93 transient ischaemic attacks were incident events. Despite more complete case-ascertainment than in OCSP, age-adjusted and sex-adjusted incidence of first-ever stroke fell by 29% (relative incidence 0.71, 95% CI 0.61-0.83, p=0.0002). Incidence declined by more than 50% for primary intracerebral haemorrhage (0.47, 0.27-0.83, p=0.01) but was unchanged for subarachnoid haemorrhage (0.83, 0.44-1.57, p=0.57). Thus, although 28% more incident strokes (366 vs 286) were expected in OXVASC due to demographic change alone (33% increase in those aged 75 or older), the observed number fell (262 vs 286). Major reductions were recorded in mortality rates for incident stroke (0.63, 0.44-0.90, p=0.02) and in incidence of disabling or fatal stroke (0.60, 0.50-0.73, p<0.0001), but no change was seen in case-fatality due to incident stroke (17.2% vs 17.8%; age and sex adjusted relative risk 0.85, 95% CI 0.57-1.28, p=0.45). Comparison of premorbid risk factors revealed substantial reductions in the proportion of smokers, mean total cholesterol, and mean systolic and diastolic blood pressures and major increases in premorbid treatment with antiplatelet, lipid-lowering, and blood pressure lowering drugs (all p<0.0001). The age-specific incidence of major stroke in Oxfordshire has fallen by 40% over the past 20 years in association with increased use of preventive treatments and major reductions in premorbid risk factors.
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            ICF linking rules: an update based on lessons learned.

            Outcome research seeks to understand the end results of health services. Researchers use a wide variety of outcome measures including technical, clinical and patient-oriented measures. The International Classification of Functioning, Disability and Health (ICF) as a common reference framework for functioning may contribute to improved outcome research. The objective of this paper is to provide an updated version of the linking rules published in 2002 and illustrate how these rules are applied to link technical and clinical measures, health-status measures and interventions to the ICF. Three specific linking rules have been established to link health-status measures to the ICF and one specific linking rule has been created to link technical and clinical measures and interventions. A total of 8 linking rules have been established for use with all different outcome measures and with interventions. The newly updated linking rules will allow researchers systematically to link and compare meaningful concepts contained in them. This should prove extremely useful in selecting the most appropriate outcome measures among a number of candidate measures for the applied interventions. Further possible applications are the operationalization of concrete ICF categories using specific measures or the creation of ICF category-based item bankings.
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              Étude comparative de la distribution florale dans une portion des Alpes et du Jura

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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                16 June 2020
                June 2020
                : 17
                : 12
                : 4291
                Affiliations
                [1 ]School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; cesaremaria.cornaggia@ 123456unimib.it (C.M.C.); cesare.cerri@ 123456unimib.it (C.G.C.); daniele.piscitelli@ 123456mcgill.ca (D.P.)
                [2 ]Casa di cura Beato Palazzolo, 24122 Bergamo, Italy; marta.bolis@ 123456casadicurapalazzolo.it
                [3 ]Istituti Clinici Zucchi, 20841 Carate Brianza, Italy; marco.limonta@ 123456grupposandonato.it
                [4 ]Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, 4671 Differdange, Luxembourg; roberto.meroni@ 123456lunex-university.net
                [5 ]Department of Statistics, Wroclaw University of Economics, 53-345 Wrocław, Poland; katarzyna.ostasiewicz@ 123456ue.wroc.pl
                [6 ]Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo 03071-000, Brazil; salouche@ 123456uol.com.br
                [7 ]Associação de Assistência à Criança Deficiente (AACD), 04027-000 São Paulo, Brazil; gmatuti@ 123456aacd.org.br
                [8 ]School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
                Author notes
                [* ]Correspondence: cecilia.perin@ 123456unimib.it ; Tel.: +39-03-6298-6446; Fax: +39-03-6298-6439
                Author information
                https://orcid.org/0000-0002-0448-4693
                https://orcid.org/0000-0002-5717-1148
                https://orcid.org/0000-0001-7909-3673
                https://orcid.org/0000-0002-5240-3798
                Article
                ijerph-17-04291
                10.3390/ijerph17124291
                7345505
                32560129
                a95c44e3-10a5-4f58-8cf3-533f78a46467
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 08 May 2020
                : 11 June 2020
                Categories
                Article

                Public health
                international classification of functioning,disability and health,stroke,personal factors,rehabilitation,age

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